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Fetal aortic valve stenosis: a critique of case selection criteria for fetal intervention
Author(s) -
Hunter Lindsey E.,
Chubb Henry,
Miller Owen,
Sharland Gurleen,
Simpson John M.
Publication year - 2015
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.4661
Subject(s) - fetus , medicine , stenosis , cardiology , selection (genetic algorithm) , fetal echocardiography , aortic valve stenosis , aortic valve , intervention (counseling) , prenatal diagnosis , pregnancy , computer science , genetics , biology , artificial intelligence , psychiatry
Objective Selection of fetuses with aortic stenosis (AS) for prenatal intervention has been influenced by published scoring systems. This study aimed to test these scoring systems by retrospective application to consecutive cases of fetal AS. Methods Retrospective analysis of the echocardiographic findings of 31 consecutive fetuses with AS evaluated at a tertiary fetal cardiology centre. Published ‘eHLHS’ scores and threshold scores were applied to the group and compared to postnatal management, in terms of biventricular repair versus single ventricle palliation. Results Thirty‐one fetuses were identified with AS, and eHLHS was identified in 17 at the initial echocardiogram. No fetus with a full eHLHS score (3/3 or 4/4) achieved a biventricular repair. Three fetuses had a favourable threshold score (≥4), one of whom had a successful biventricular outcome. Seven fetuses had an unfavourable threshold score (<4) and underwent a univentricular pathway. Conclusion The eHLHS score is a reliable predictor for the progression to HLHS at term. The score identifies those who would achieve a biventricular repair postnatally without prenatal intervention. A minority of fetuses with favourable threshold scores may achieve a biventricular repair postnatally without prenatal intervention, but eHLHS and an unfavourable threshold score (<4) predict a single ventricle pathway postnatally. © 2015 John Wiley & Sons, Ltd.